CAJ | 학술논문

目的探讨扩张型心肌病(DCM)患者窦性心率震荡(HRT)及QT离散度(QTa)与心功能变化的相关性及临床价值.方法 81例临床诊断DCM伴室性早搏患者,按心功能分级分组:A组(心功能Ⅰ～Ⅱ级)34例,B组(心功能Ⅲ～Ⅳ级)47例,并选取同期健康人群30名为对照.24 h动态心电图检测各组HRT参数:震荡初始(TO)和震荡斜率(TS),体表12导联心电图测定QTd,同时超声心动图测量左室射血分数(LVEF)、左室舒张末内径(LVEDD),E、A峰值及E/A比值;各组间比较且对TO、TS、QTd与心功能指标进行相关性分析.结果与健康对照组比较,DCM A、B两组患者TO值显著增高[0.38(-0.99～1.85)%比1.82(0.02～3.92)%比(-4.03±3.48)%,P＜0.01];TS值明显降低(P＜0.01),QTd增加[(54±15)ms比(71±18)ms比(32±13)ms];且随着心功能恶化QTd增加越趋明显.TO与LVEF呈负相关(r=-0.701,P＜0.05),与LVEDD呈正相关(r=0.621,P＜0.05),与E峰及A峰值无相关性;TS和QTd与LVEF、LVEDD也有显著相关性(均P＜0.05).结论 DCM患者HRT现象减弱,HRT和QTd变化与患者心功能恶化相一致,联合检测对评价DCM患者自主神经功能状态及预后有较高的临床价值.
목적 탐토확장형심기병(DCM)환자두성심솔진탕(HRT)급QT리산도(QTa)여심공능변화적상관성급림상개치.방법 81례림상진단DCM반실성조박환자,안심공능분급분조:A조(심공능Ⅰ～Ⅱ급)34례,B조(심공능Ⅲ～Ⅳ급)47례,병선취동기건강인군30명위대조.24 h동태심전도검측각조HRT삼수:진탕초시(TO)화진탕사솔(TS),체표12도련심전도측정QTd,동시초성심동도측량좌실사혈분수(LVEF)、좌실서장말내경(LVEDD),E、A봉치급E/A비치;각조간비교차대TO、TS、QTd여심공능지표진행상관성분석.결과 여건강대조조비교,DCM A、B량조환자TO치현저증고[0.38(-0.99～1.85)%비1.82(0.02～3.92)%비(-4.03±3.48)%,P＜0.01];TS치명현강저(P＜0.01),QTd증가[(54±15)ms비(71±18)ms비(32±13)ms];차수착심공능악화QTd증가월추명현.TO여LVEF정부상관(r=-0.701,P＜0.05),여LVEDD정정상관(r=0.621,P＜0.05),여E봉급A봉치무상관성;TS화QTd여LVEF、LVEDD야유현저상관성(균P＜0.05).결론 DCM환자HRT현상감약,HRT화QTd변화여환자심공능악화상일치,연합검측대평개DCM환자자주신경공능상태급예후유교고적림상개치.
Objective To explore the relationship among heart rate turbulence (HRT), QT dispersion (QTd) and heart function in patients with dilated cardiomyopathy (DCM) and assess its clinical value. Methods A total of 81 DCM patients with ventricular premature contraction (VPC) were divided into two groups according to heart function: Group A (NYHA class Ⅰ -Ⅱ , n = 34) and Group B (NYHA class Ⅲ-V, n =47). Thirty out-patient control cases were chosen from those undergoing regular physical examination. 24hour holter was performed to monitor turbulence onset ( TO ) and turbulence slope (TS).Electrocardiogram (ECG) was used to assess QTd. Meanwhile left ventricular ejection fraction ( LVEF),left ventricular end-diastolic dimension ( LVEDD), E and A-wave peak velocities, E/A were measured by echocardiogram. After a comparison of all indicators in each group, an investigation was conducted to discern the relationship among HRT, QTd and heart function. Results Compared with normal group, TO significantly increased in DCM A and B group: [0. 38 ( - 0.99 ～ 1.85 ) % vs 1.82 ( 0. 02 ～ 3.92 ) % vs ( -4. 03 ± 3.48 )%, P ＜ 0. 01]. TS significantly decreased while QTd increased. The trend of QTd addition was apparent along with heart failure. TO was negatively correlated with LVEF ( r = -0. 701, P ＜0. 05 ) but positively correlated with LVEDD ( r =0. 621, P ＜0. 05 ). There was no correlation with E and A-wave peak velocities. TS and QTd also had an obvious correlation with LVEF and LVEDD ( all P ＜ 0. 05 ) .Conclusions HRT is dramatically blunted in DCM patients and has a certain correlation with cardiac dysfunction. A combined test of HRT and QTd is a sensitive and indirect index in assessing autonomic nerve functions. It has a high clinical value of predicting the prognosis.